Dilemma in Managing Thyroglossal Duct Cyst Carcinoma

The thyroglossal duct cyst (TGDC) is a well-known developmental abnormality encountered in the neck. It represents over 75% of childhood midline neck masses and 7% of the adult population. It typically presents as a mobile, painless mass in the anterior midline of the neck, usually in close junction to the hyoid bone. TGDCs infrequently present with signs and symptoms of secondary infection, or with evidence of a fistula. Malignancy is rarely encountered in TGDCs approximately in 1.5% of patients. We present an interesting and rare case of elderly female who presented with an asymptomatic neck mass. CT scan of neck with contrast showed lobulated vascular enhancing mass 3.1 cm in size with no significant lymphadenopathy. Fine needle aspiration of neck mass revealed papillary carcinoma. She underwent Sistrunk procedure with total thyroidectomy and central neck dissection followed by radioactive iodine (RAI) and thyroid hormone suppression. Since the incidence of TGDC carcinoma is low, controversy exists in its management in relation to type and the extent of surgery and use of RAI.